covered california...advisory group jeanne cain executive vice president, policy california chamber...
TRANSCRIPT
Covered California
Small Business Health Options Program (SHOP) Advisory Group
October 16, 2013
I. Welcome and Introductions
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Small Business Health Options Program (SHOP)
Advisory Group
Jeanne Cain
Executive Vice President, Policy
California Chamber of Commerce
David Chase
California Outreach Director
Small Business Majority
Jorge C. Corralejo
Chairman, Founding Member
Latino Business Chamber of Greater
Los Angeles
Virginia Donohue (Chair)
Small Business Owner
Pet Camp
Tana Elizondo
Insurance Agent
Central Valley Life & Health Benefits
Kathleen Hamilton
Director, Government Affairs
The Children's Partnership
Brent Hitchings
Vice President
Sales and Account Management
Blue Shield of California
Alan Katz
Executive Vice President
SeeChange Health
Emily Lam
Senior Director
Healthcare & Federal Issues
Silicon Valley Leadership Group
Gohn Marie McFadden
President and Founder
McFadden & Associates Insurance
John Newman
Executive Director
California Exchange Operations
Kaiser Permanente Health Plan
Carla Saporta
Policy Director
Greenlining Institute
MD Sam Smith
President Elect of CAHU
Independent Agent & CAHU
Micah Weinberg
Senior Policy Advisor
Bay Area Council
Barbara Vohryzek (Ex Officio)
Small Business Advocate
California Governor’s Office of
Business and Economic Development
Covered California Board
Participants
Paul Fearer
Susan Kennedy
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Covered CA SHOP
Dianne Koelzer
SHOP Interim Director
Covered CA
Anne Gezi
SHOP Manager
Covered CA
Bobbie Moore
SHOP Technical & Operations Liaison
Covered CA
Becky Thomas
SHOP Contracts Manager
Covered CA
Corky Goodwin
Policy Advisor
The Tori Group
Dan Frey
Agent Advisor
The Tori Group
Pat Flynn & Karen Meyers
SHOP Project Managers
Quantum Consulting
David Zanze
President / Executive Sponsor
Pinnacle Claims Management, Inc.
Patty Benkowski
VP Operations / Project Director
Pinnacle Claims Management, Inc.
Steve Mangapit
AVP Operations
Pinnacle Claims Management, Inc.
Chris Patton
VP Agent Sales & Management
Pinnacle Claims Management, Inc.
Shawn Balsdon
N. Director Agent Sales & Mgmt.
Pinnacle Claims Management, Inc.
Rich Hines
S. Director Agent Sales & Mgmt.
Pinnacle Claims Management, Inc.
Alberta Forester
Director, Service Center
Pinnacle Claims Management, Inc.
Damian Williams
Chief Information Officer
Pinnacle Claims Management, Inc.
Mark Noakes
Project Manager
Pinnacle Claims Management, Inc.
Natalie Krosel
Manager, PR & Communications
Pinnacle Claims Management, Inc.
Janice Tessen
Director, Eligibility & Enrollment
Pinnacle Claims Management, Inc.
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II. CalHEERS Availability & Functionality
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CalHEERS Update
• Update on October 1 Release
• Update on Future Releases
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III. SHOP Go-Live Status Report
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SHOP Go-Live Status Report
• SHOP Update – Added additional 17 Service Center Reps to our
Call Center Team
– Added an additional 6 eligibility and enrollment specialists
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SHOP Go-Live Status Report
• Call Center Update
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Calls Offered Calls Answered
Average
Handle
Time36,939 21,643 6.31
Top Reasons for Contacting Call Center
1. Questions on how to complete Agent Agreement 2. Agents are loaded in PayPal but not receiving email to submit documents 3. Program questions 4. Agents having issues making payment via PayPal for endorsement fee 5. Checking status on submitted paperwork via [email protected] 6. LMS Modules not working correctly 7. Agents unable to get into CALHEERS
SHOP Go-Live Status Report
• Agent Certification & Training – Agents Registered in CalHEERS = 17,768 – Agents in the Training Process = 10,432*
– Agents who have passed the Exam = 5,239**
– Agents Certified in CalHEERS = 1,344 – Agents with Incomplete Paperwork = 1,400
*Does not include those who have passed the exam **Not all Agents who have passed the Exam have submitted paperwork or paid
• Quoting Activity
– 104 Requests for Quotes • 630 Employees • Average Group Size ~6 • 35% Agent Submitted
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SHOP Go-Live Status Report
• General Agents - Instructor Led Training
• Warner Pacific 1,730
• Claremont 998
• LISI 966
• Dickerson 270
• CAHU 300
TOTAL 4,264
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SHOP Health Plans
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Region1: Alpine, Del Norte, Siskiyuo, Modoc, Lassen, Shasta, Trinity, Humboldt, Tehama, Plumas, Nevada,
Sierra, Mendocino, Lake Butte, Glenn, Sutter, Yuba, Colusa, Amador, Calaveras, Tuolumne
Metal Level Lowest 2nd 3rd 4th 5th 6th
Platinum Kaiser - Copay HMO Western Health
Advantage - Copay HMO
Blue Shield- Copay HMO HealthNet - Coin PPO
Gold Kaiser - Copay HMO Western Health
Advantage - Copay HMO
HealthNet - Coin PPO Blue Shield- Copay HMO
Silver Kaiser - HSA HMO Kaiser - Copay HMO Western Health
Advantage - HSA HMO
Western Health
Advantage - Copay HMO
HealthNet - Coin PPO Blue Shield- Copay HMO
Bronze Kaiser - HSA HMO Kaiser - Coin HMO Western Health
Advantage - Copay HMO
Western Health
Advantage - HSA HMO
Blue Shield- Coin PPO HealthNet - Coin PPO
Region 2: Napa, Sonoma, Solano, Marin
Metal Level Lowest 2nd 3rd 4th 5th 6th
Platinum Kaiser - Copay HMO Western Health
Advantage - Copay HMO
Blue Shield- Copay HMO HealthNet - Coin PPO
Gold Kaiser - Copay HMO Western Health
Advantage - Copay HMO
HealthNet - Coin PPO Blue Shield- Copay HMO
Silver Kaiser - HSA HMO Kaiser - Copay HMO Western Health
Advantage - HSA HMO
Western Health
Advantage- Coin HMO
HealthNet - Coin PPO Blue Shield- Copay HMO
Bronze Kaiser - HSA HMO Kaiser - Coin HMO Western Health
Advantage - Coin HMO
Western Health
Advantage - HSA HMO
HealthNet - Coin PPO Blue Shield- Coin PPO
Region 3: Sacramento, El Dorado, Placer, Yolo
Metal Level Lowest 2nd 3rd 4th 5th 6th
Platinum Kaiser - Copay HMO Western Health
Advantage - Copay HMO
HealthNet - Coin PPO Blue Shield- Copay HMO
Gold Kaiser - Copay HMO HealthNet - Coin PPO Western Health
Advantage - Copay HMO
Blue Shield- Copay HMO
Silver Kaiser - HSA HMO Kaiser - Copay HMO Western Health
Advantage - HSA HMO
Western Health
Advantage - Copay HMO
HealthNet - Coin PPO Blue Shield- Copay HMO
Bronze Kaiser - HSA HMO Kaiser - Coin HMO Western Health
Advantage - Copay HMO
Western Health
Advantage - HSA HMO
HealthNet - Coin PPO Blue Shield- Coin PPO
SHOP Health Plans
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Region 4: San Francisco
Metal Level Lowest 2nd 3rd 4th 5th
Platinum Chinese Community
Health Plan - Copay HMO
Kaiser - Copay HMO Blue Shield- Copay HMO HealthNet - Coin PPO **Based on 2nd lowest rate
Gold Chinese Community
Health Plan - Copay HMO
Kaiser - Copay HMO HealthNet - Coin PPO Blue Shield- Copay HMO
Silver Chinese Community
Health Plan - Copay HMO
Kaiser - HSA HMO Kaiser - Copay HMO HealthNet - Coin PPO Blue Shield- Copay HMO
Bronze Chinese Community
Health Plan - Copay HMO
Kaiser - HSA HMO Kaiser - Coin HMO HealthNet - Coin PPO Blue Shield- Coin PPO
Region 5: Contra Costa
Metal Level Lowest 2nd 3rd 4th
Platinum Kaiser - Copay HMO HealthNet - Coin PPO Blue Shield- Copay HMO
Gold Kaiser - Copay HMO HealthNet - Coin PPO Blue Shield- Copay HMO
Silver Kaiser - HSA HMO Kaiser - Copay HMO HealthNet - Coin PPO Blue Shield- Copay HMO
Bronze Kaiser - HSA HMO Kaiser - Coin HMO HealthNet - Coin PPO Blue Shield- Coin PPO
Region 6: Alameda
Metal Level Lowest 2nd 3rd 4th
Platinum Kaiser - Copay HMO HealthNet - Coin PPO Blue Shield- Copay HMO
Gold Kaiser - Copay HMO HealthNet - Coin PPO Blue Shield- Copay HMO
Silver Kaiser - HSA HMO Kaiser - Copay HMO HealthNet - Coin PPO Blue Shield- Copay HMO
Bronze Kaiser - HSA HMO Kaiser - Coin HMO HealthNet - Coin PPO Blue Shield- Coin PPO
SHOP Health Plans Region 7: Santa Clara
Metal Level Lowest 2nd 3rd 4th
Platinum Kaiser - Copay HMO Blue Shield- Copay HMO HealthNet - Coin PPO
Gold Kaiser - Copay HMO HealthNet - Coin PPO Blue Shield- Copay HMO
Silver Kaiser - HSA HMO Kaiser - Copay HMO HealthNet - Coin PPO Blue Shield- Copay HMO
Bronze Kaiser - HSA HMO Kaiser - Coin HMO HealthNet - Coin PPO Blue Shield- Coin PPO
Region 8: San Mateo
Metal Level Lowest 2nd 3rd 4th 5th
Platinum Chinese Community
Health Plan - Copay HMO
Kaiser - Copay HMO Blue Shield- Copay HMO HealthNet - Coin PPO
Gold Chinese Community
Health Plan - Copay HMO
Kaiser - Copay HMO HealthNet - Coin PPO Blue Shield- Copay HMO
Silver Chinese Community
Health Plan - Copay HMO
Kaiser - HSA HMO Kaiser - Copay HMO HealthNet - Coin PPO Blue Shield- Copay HMO
Bronze Chinese Community
Health Plan - Copay HMO
Kaiser - HSA HMO Kaiser - Coin HMO HealthNet - Coin PPO Blue Shield- Coin PPO
Region 9: Santa Cruz, Monterey, San Benito
Metal Level Lowest 2nd 3rd 4th
Platinum Kaiser - Copay HMO HealthNet - Coin PPO Blue Shield- Copay HMO
Gold Kaiser - Copay HMO HealthNet - Coin PPO Blue Shield- Copay HMO
Silver Kaiser - HSA HMO Kaiser - Copay HMO HealthNet - Coin PPO Blue Shield- Copay HMO
Bronze Kaiser - HSA HMO Kaiser - Coin HMO HealthNet - Coin PPO Blue Shield- Coin PPO
SHOP Health Plans Region 10: San Joaquin, Stanislaus, Merced, Mariposa, Tulare
Metal Level Lowest 2nd 3rd 4th
Platinum Kaiser - Copay HMO Blue Shield- Copay HMO HealthNet - Coin PPO
Gold Kaiser - Copay HMO HealthNet - Coin PPO Blue Shield- Copay HMO
Silver Kaiser - HSA HMO Kaiser - Copay HMO HealthNet - Coin PPO Blue Shield- Copay HMO
Bronze Kaiser - HSA HMO Kaiser - Coin HMO Blue Shield- Coin PPO HealthNet - Coin PPO
Region 11: Fresno, Kings, Madera
Metal Level Lowest 2nd 3rd 4th
Platinum Kaiser - Copay HMO HealthNet - Coin PPO Blue Shield- Copay HMO
Gold HealthNet - Coin PPO Kaiser - Copay HMO Blue Shield- Copay HMO
Silver Kaiser - HSA HMO Kaiser - Copay HMO HealthNet - Coin PPO Blue Shield- Copay HMO
Bronze Kaiser - HSA HMO Kaiser - Coin HMO HealthNet - Coin PPO Blue Shield- Coin PPO
Region 12: San Luis Obispo, Santa Barbara, Ventura
Metal Level Lowest 2nd 3rd 4th
Platinum Kaiser - Copay HMO Blue Shield- Copay HMO HealthNet - Coin PPO
Gold Kaiser - Copay HMO Blue Shield- Copay HMO HealthNet - Coin PPO
Silver Kaiser - HSA HMO Kaiser - Copay HMO HealthNet - Coin PPO Blue Shield- Copay HMO
Bronze Kaiser - HSA HMO Kaiser - Coin HMO HealthNet - Coin PPO Blue Shield- Coin PPO
SHOP Health Plans Region 13: Mono, Inyo, Imperial
Metal Level Lowest 2nd 3rd 4th
Platinum Kaiser - Copay HMO Blue Shield- Copay HMO HealthNet - Coin PPO
Gold Kaiser - Copay HMO HealthNet - Coin PPO Blue Shield- Copay HMO
Silver Kaiser - HSA HMO Kaiser - Copay HMO HealthNet - Coin PPO Blue Shield- Copay HMO
Bronze Kaiser - HSA HMO Kaiser - Coin HMO HealthNet - Coin PPO Blue Shield- Coin PPO
Region 14: Kern
Metal Level Lowest 2nd 3rd 4th
Platinum Kaiser - Copay HMO HealthNet - Coin PPO Blue Shield- Copay HMO
Gold Kaiser - Copay HMO HealthNet - Coin PPO Blue Shield- Copay HMO
Silver Kaiser - HSA HMO Kaiser - Copay HMO HealthNet - Coin PPO Blue Shield- Copay HMO
Bronze Kaiser - HSA HMO Kaiser - Coin HMO HealthNet - Coin PPO Blue Shield- Coin PPO
Region 15: Los Angeles (North)
Metal Level Lowest 2nd 3rd 4th
Platinum Blue Shield- Copay HMO Kaiser - Copay HMO HealthNet - Coin PPO
Gold Blue Shield- Copay HMO Kaiser - Copay HMO HealthNet - Coin PPO
Silver Kaiser - HSA HMO Kaiser - Copay HMO Blue Shield- Copay HMO HealthNet - Coin PPO
Bronze Kaiser - HSA HMO Kaiser - Coin HMO HealthNet - Coin PPO Blue Shield- Coin PPO
SHOP Health Plans Region 16: Los Angeles (South)
Metal Level Lowest 2nd 3rd 4th
Platinum Blue Shield- Copay HMO Kaiser - Copay HMO HealthNet - Coin PPO
Gold Blue Shield- Copay HMO Kaiser - Copay HMO HealthNet - Coin PPO
Silver Blue Shield- Copay HMO Kaiser - HSA HMO Kaiser - Coin HMO HealthNet - Coin PPO
Bronze Kaiser - HSA HMO Kaiser - Coin HMO HealthNet - Coin PPO Blue Shield- Coin PPO
Region 17: Riverside, San Bernadino
Metal Level Lowest 2nd 3rd 4th
Platinum Kaiser - Copay HMO Blue Shield- Copay HMO HealthNet - Coin PPO
Gold Kaiser - Copay HMO Blue Shield- Copay HMO HealthNet - Coin PPO
Silver Kaiser - HSA HMO Kaiser - Copay HMO HealthNet - Coin PPO Blue Shield- Copay HMO
Bronze Kaiser - HSA HMO Kaiser - Coin HMO HealthNet - Coin PPO Blue Shield- Coin PPO
Region 18: Orange
Metal Level Lowest 2nd 3rd 4th
Platinum Blue Shield- Copay HMO Kaiser - Copay HMO HealthNet - Coin PPO
Gold Kaiser - Copay HMO Blue Shield- Copay HMO HealthNet - Coin PPO
Silver Kaiser - HSA HMO Kaiser - Coin HMO HealthNet - Coin PPO Blue Shield- Copay HMO
Bronze Kaiser - HSA HMO Kaiser - Coin HMO HealthNet - Coin PPO Blue Shield- Coin PPO
SHOP Health Plans
Region 19: San Diego
Metal Level Lowest 2nd 3rd 4th 5th 6th 7th
Platinum Kaiser - Copay HMO Sharp - Copay HMO Sharp - Coin HMO HealthNet - Coin PPO Blue Shield- Copay HMO
Gold Kaiser - Copay HMO Sharp - Copay HMO Sharp - Coin HMO HealthNet - Coin PPO Blue Shield- Copay HMO
Silver Kaiser - HSA HMO Kaiser - Copay HMO Sharp - HSA HMO Sharp - Copay HMO Sharp - Coin HMO HealthNet - Coin PPO Blue Shield- Copay HMO
Bronze Kaiser - HSA HMO Kaiser - Coin HMO Sharp - HSA HMO Sharp - Coin HMO HealthNet - Coin PPO Blue Shield- Coin PPO
IV. Outreach & Education Update
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Outreach & Education
• Grantees – Over 100 Outreach & Education Activities
– Generating over 750 small business leads
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V. Applications
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SHOP Applications
Employer Application – Mimicked Federal employer application
– Includes a page that outlines the documents required to verify employer eligibility
– Employee roster pages are optional and absolutely not necessary if all employee applications are submitted at the same time
Employee Application – Includes a statement that allows an employee to indicate no
dependent coverage offered
– All qualified employees declining coverage must sign and date the app
– All dependents of qualified employees declining coverage must be indicated on the app
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VI. Website Improvements
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Websites
• Small Business Website
• Agent Website
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VII. Dispute & Appeals Process
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SHOP Dispute & Appeals Regulations
Article and Sections of the SHOP Draft Proposed Dispute & Appeals Regulations:
Article 6.
Sections: Table of Contents:
§ 6540 Definitions
§ 6542 General Eligibility Appeals Requirements for SHOP
§ 6544 Informal Resolution
§ 6546 Hearing Requirements
§ 6548 Dismissal of Appeals
§ 6550 Expedited Appeals Process
§ 6552 Appeals Decisions
Dispute & Appeals Process Highlights
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SHOP Service Center receives appeal and forwards to DSS to schedule hearing date.
Appeal is received at DSS.
SHOP continues the informal resolution process.
Unresolved case is received at SHOP HQ.
Appeal is handled by DSS/State Hearings Division.
HQ closes the case.
Re-Hearing: Claimant appeals to Department of HHS.
SHOP Key Dates
Activity Projected Date
Covered CA Launch October 1
Fourth Quarter Advisory Group Meeting October 16
Stakeholder Review of Draft Proposed Dispute & Appeals Regulations October 15 – October 18
Stakeholder Review of Employer & Employee Applications October 15 – October 18
Board Meeting October 24
CalHEERS Release 2.5 Functionality November 19
Coverage Effective Date January 1, 2014
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Next Steps
Open Discussion
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SHOP Value Proposition
• Tax Credit
• Aggregate Premium
• Aggregate Billing
• Employee Choice
• Transparency
• Plans Comparison “Apples to Apples”
• Convenient Platform
• Direct hand-off to Individual Market
• Defined Contribution
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Covered CA - Vision and Mission
Vision
The vision of Covered California is to improve the health of all
Californians by assuring their access to affordable, high quality care.
Mission
The mission of the Covered California is to increase the number of
insured Californians, improve health care quality, lower costs, and
reduce health disparities through an innovative, competitive
marketplace that empowers consumers to choose the health plan and
providers that give them the best value.
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Covered California’s Values
Integrity The Exchange will earn the public’s trust through its commitment to accountability, responsiveness, transparency, speed, agility, reliability, and cooperation.
Partnership The Exchange welcomes partnerships, and its efforts will be guided by working with consumers, providers, health plans, employers and other purchasers, government partners, and other stakeholders.
Results The impact of the Exchange will be measured by its contributions to expanding coverage and access, improving health care quality, promoting better health and health equity, and lowering costs for all Californians.
Consumer-focused At the center of the Exchange’s efforts are the people it serves, including patients and their families, and small business owners and their employees. The Exchange will offer a consumer-friendly experience that is accessible to all Californians, recognizing the diverse cultural, language, economic, educational and health status needs of those we serve.
Affordability The Exchange will provide affordable health insurance while assuring quality and access.
Catalyst The Exchange will be a catalyst for change in California’s health care system, using its market role to stimulate new strategies for providing high-quality, affordable health care, promoting prevention and wellness, and reducing health disparities.
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Collateral and Messaging
• Preview of the Grantee draft collateral material
• Show the SHOP advertisements and plan for
future ads
• Describe the messaging and testing feedback
learned from past focus groups and surveys
• Share feedback learned from Grantee training
related to materials
• Next steps?
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Covered California Governance Independent Public Entity with Qualified Board
Diana Dooley, Board Chair and Secretary of the California Health and Human Services Agency,
which provides a range of health care services, social services, mental health services, alcohol and
drug treatment services, income assistance and public health services to Californians
Kim Belshé, Senior Policy Advisor of the Public Policy Institute of California, former Secretary of
California Health and Human Services Agency, and former Director of the California Department of
Health Services
Paul Fearer, Senior Executive Vice President and Director of Human Resources of
UnionBanCalCorporation and its primary subsidiary, Union Bank N.A., Board Chair of Pacific
Business Group on Health, and former board chair of Pacific Health Advantage
Robert Ross, M.D., President and Chief Executive Officer of The California Endowment, previous
director of the San Diego County Health and Human Services Agency from 1993 to 2000, and
previous Commissioner of Public Health for the City of Philadelphia from 1990 to 1993
Susan Kennedy, Nationally-recognized policy consultant, former Deputy Chief of Staff and Cabinet
Secretary to Governor Gray Davis, former Chief of Staff to Governor Arnold Schwarzenegger,
former Communications Director for U.S. Senator Dianne Feinstein, and former Executive Director
of the California Democratic Party
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Foundations of Covered California’s Success
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Commitment to Transparency
• We are very public: • Public Records Act: The Public has the right to inspect and/or obtain
copies of public records maintained by Covered California.
• Assume all emails will be in the LA Times
• Meetings are public
• Advisory group discussions – individuals’ comments will NOT be treated as “positions” of the organizations they represent, but press and the public will be at quarterly meetings
• Advisory Group members may be contacted by media organizations, but do not “represent” Covered California
• Covered California may informally reach out to some or all of the Advisory Group for input between meetings.
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Small Business Health Options Program Advisory Group Charter
• Purpose: To provide advice and recommendations and serve as a sounding board to Covered California to assist in the continual refinement of policies and strategies to ensure we offer a unique value to small businesses that purchase coverage through SHOP.
• Scope: Provide input on strategies to raise interest in the SHOP and ensure that it provides value for small employers.
• Structure: Advisory Group members are selected for an initial two-year term and meet quarterly. The SHOP Advisory Chairperson will serve a one-year term.
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